Palpation is commonly used in open surgery to manually detect tissue abnormalities. Manual palpation typically requires open surgery with large incisions, and therefore longer recovery times for the patient. During open surgery, surgeons use their hands to access the anatomy and to feel their way around sensitive anatomical structures and to correlate the actual anatomy with preoperative data. Examples where surgeons employ manual palpation include identification of underlying arteries during dissection, identification of hepatic aneurysms during liver surgery, intramedullary fixation of tibia and femur during orthopedic surgery, assistance during adenoidectomy procedures, and identification of laryngeal nerves during thyroid surgery. Additional examples includes surgeons using manual palpation to search for abnormalities such as breast masses, cancer, heart and liver enlargement, to identify active ulcers, and to localize aneurysms.
Manual palpation capabilities are unfortunately lost during minimally invasive surgery (“MIS”), which has many other advantages such as trauma reduction, improved cosmesis, shortened recovery time, and reduced hospitalization costs.
Some devices that restore palpation feedback have been proposed for MIS, but none of them have been translated to clinical application thus far. One of the main reasons is that devoting one of the few abdominal access ports in a minimally invasive procedure to an instrument that tries to restore palpation has never been considered to be a wise investment for the sake of surgical outcomes. Despite progress in robotic assistance, existing MIS robotic systems do not support palpation, and they are predominantly passive “motion replicators” (i.e., the robot grippers follow direct or scaled motions of the surgeon's hands). To date, there are no algorithms that enable robots to use in-vivo sensory palpation data to actively augment the surgeon's perception of the surgical field or assist in in vivo diagnostics and in task execution. Also, from a design perspective, existing robotic MIS systems are increasingly able to restore dexterous surgical intervention capabilities typically available to surgeons during open surgery. These systems however, are limited by both physical designs and by their control algorithms. Design limitations restrict their use to trans-cutaneous access in bodily cavities by using 3-5 access ports while having a physical connection to extracorporeal actuation devices, which limit end-effector travel within the patient's body.
A wireless palpation technique would not consume port space and can be used beyond minimally invasive surgery, whenever the proposed invention can be introduced by natural orifices or tiny incisions.